Coding Auditor

HealthFirst•Remote - NY, NY

2d•$61,300 - $99,620•Remote

About The Position

The Coding Auditor conducts quality audits to ensure that medical diagnostic codes submitted to CMS (Centers for Medicare and Medicaid Services), New York State Department of Health (NYSDOH), and other entities are accurate based on the practitioners' medical record documentation of Healthfirst members' health conditions.

Requirements

Coding certification from either American Academy of Professional Coders (AAPC) or Certified Professional Coders (CPC) or American Health Information Management Association (AHIMA).
High school diploma or GED.

Nice To Haves

Previous relevant experience
Time management, critical/creative thinking, communication, and problem-solving skills
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
Demonstrated professional writing, electronic documentation, and assessment skills.
Intermediate Outlook, Basic Word, Excel, PowerPoint, Adobe Acrobat skills.
Knowledge of ICD10 and anatomy and pathophysiology medical terminologies.

Responsibilities

Audits data, claim submissions, and member medical records for completeness, accuracy, and compliance with Healthfirst policy and documents findings per departmental procedure
Identifies patterns of under-performance, noncompliance, and inconsistencies and recommends resolutions
Evaluates the quality of medical coding and notifies management of discrepancies, as needed.
Conducts internal audits of medical record reviews performed by colleagues
Collaborates with other departments to improve compliance with coding conventions and clinical practice guidelines
Supports continuous improvement and quality initiatives to improve processes across departments.
Additional duties as assigned